Growing up I was a good student, but had to apply myself for A’s. Correction, gym was very easy for me, but math was not. I have yet to be in an interview where my potential employer asked me what my grade point was, so what was all the hard work for anyway?

But with cancer grades DO make a difference with treatment. Below is information to help you understand what size, grade and stage means.

Cancer size and grade

Size

The size (diameter) of breast cancer is usually measured in centimetres.

Although – in general – the smaller the cancer the better, size doesn’t always give the whole picture about how fast the cancer is growing.

For example, a small cancer may grow very quickly or a larger cancer may have been growing slowly over a long time. Sometimes there may be more than one area of breast cancer. In this case, each area is measured.

Multi-centric means there is more than one area of breast cancer in different quarters of the breast.

Multi-focal means more than one area has been seen but only in one quarter of the breast.

Treatment options

You are more likely to have chemotherapy if your breast cancer is larger than 2cm (about three quarters of an inch), but this will also depend on the other results from the pathology report.

This is because larger cancers may have been there for longer before being found so may have had more chance to spread.

Grade

Cancer cells are graded according to how different they are to normal breast cells and how quickly they are growing.

In your pathology report this may be called differentiation.

There are three grades:

grade 1 (well differentiated) cancer cells look most like normal cells and are usually slow-growing

Grade is a “score” that tells you how different the cancer cells’ appearance and growth patterns are from those of normal, healthy breast cells. Your pathology report will rate the cancer on a scale from 1 to 3:

Grade 1 or low grade (sometimes also called well differentiated): Grade 1 cancer cells look a little bit different from normal cells, and they grow in slow, well-organized patterns. Not that many cells are dividing to make new cancer cells.

Grade 2 or intermediate/moderate grade (moderately differentiated): Grade 2 cancer cells do not look like normal cells and are growing and dividing a little faster than normal.

Grade 3 or high grade (poorly differentiated): Grade 3 cells look very different from normal cells. They grow quickly in disorganized, irregular patterns, with many dividing to make new cancer cells.

Having a low-grade cancer is an encouraging sign. But keep in mind that higher-grade cancers may be more vulnerable than low-grade cancers to treatments such as chemotherapy and radiation therapy, which work by targeting fast-dividing cells.

Be careful not to confuse grade with stage, which is usually expressed as a number from 0 to 4 (often using Roman numerals I, II, III, IV). Stage is based on the size of the cancer and how far it has (or hasn’t) spread beyond its original location within the breast.

Stage is usually expressed as a number on a scale of 0 through IV — with stage 0 describing non-invasive cancers that remain within their original location and stage IV describing invasive cancers that have spread outside the breast to other parts of the body.

Understanding Breast Cancer Stages

Your pathology report will include information about the stage of the breast cancer — that is, whether it is limited to one area in the breast, or it has spread to healthy tissues inside the breast or to other parts of the body. Your doctor will begin to determine this during surgery to remove the cancer and look at one or more of the underarm lymph nodes, which is where breast cancer tends to travel first. He or she also may order additional blood tests or imaging tests if there is reason to believe the cancer might have spread beyond the breast.

whether the cancer has spread to other parts of the body beyond the breast

You also may see or hear certain words used to describe the stage of the breast cancer:

Local: The cancer is confined within the breast.

Regional: The lymph nodes, primarily those in the armpit, are involved.

Distant: The cancer is found in other parts of the body as well.

Sometimes doctors use the term “locally advanced” or “regionally advanced” to refer to large tumors that involve the breast skin, underlying chest structures, changes to the breast’s shape, and lymph node enlargement that is visible or that your doctor can feel during an exam.

The stage of the breast cancer can help you and your doctor understand your prognosis (the most likely outcome of the disease) and make decisions about treatment, along with all of the other results in your pathology report. Cancer stage also gives everyone a common way to describe the breast cancer, so that the results of your treatment can be compared and understood relative to that of other people.

Your doctor may use another staging system known as TNM to describe the cancer. This system is based on the size of the tumor (T), lymph node involvement (N), and whether the cancer has spread, or metastasized, to other parts of the body (M). TNM is discussed later in this section.

I had an annual physical with my GP last week. The same old pee in a cup, take some blood, step on the scale, listen to your heart and lungs and analyze your poop. Somehow, these normal tests have made me feel like I am once again myself. It has been just over five years since I was diagnosed with DCIS and about four and one half years since my treatment ended. Now, about the only time I remember I have lived through “this” is when I get a glimpse of my reconstructed breast in the mirror while hopping out of the shower. If I look quick enough, it doesn’t even register in my brain that I am different. Heck, I have even unsubscribed to many of the breast cancer resources I once followed diligently.

But all this has taken time.

The time to heal, both physically and emotionally. And now I feel good and sound and whole once again. My GP proclaimed me “healthy as a horse” with unremarkable test results and low blood cholesterol (with the good stuff very good and bad stuff, very low). My weight is in the normal range and so is my BMI. I exercise regularly, sleep 7-8 hours a night and eat wisely. So, all in all I am quite normal and am relishing that thought. Before my diagnosis my normal state was taken for granted. Five years ago at this time, all I wanted to be was normal. Today I am glowing with this revelation that to be normal is to live. And I’m living in the moment and planning for the incredible future ahead. Weddings, grand openings, new gardens, traveling, and sharing life’s adventures with my biggest gift – my husband Steve.

My wish for you is that you too find and celebrate your normal. If you currently have it, don’t take it for granted. For those of you working your way back to normal, know that I am and others are cheering you on. Just remember to celebrate when you get there and be mindful of what a gift your normal truly is.

There are times in our lives when we simply have no words. A time just after receiving some shocking news or witnessing a life changing event that leaves us utterly speechless. A time when the brain seems to replay the imprinted tape over and over to make sure it was interpreted correctly. And when we open our eyes to the same reality, we are left with an empty and sick feeling. A feeling that makes you want to run right out of your own skin. But you can’t run because you are frozen in place, in time. A sickening realization then grips our being to adjust to this new reality as shock and denial set in. It can’t be, you think. But, by the look on the face of your (fill-in-the-blank + loved one, doctor, friend), this is the state of your new reality.

Perhaps you have been here or had to deliver impossible news to another. At some point in our lives, we all suffer through physical or emotional turmoil. Someone you know is going through this right now. What is important is not the words people respond with, but their being present for us.

Let this be a reminder to comfort a friend with your presence, sit quietly or walk along side them. Be present. Simply being there is what matters.

Girls need female role models and mentors to help shape them into women of worth. Specifically, I want to recall one such woman, Jean Freeman, my former swimming coach at the University of Minnesota. Jean had a profound impact on me as an athlete and more importantly as an emerging female leader. Prior to my coming to the U of M, my swimming coaches were always men. I have nothing against men, who were very formative in my athletic development and mental preparedness. But it wasn’t until I was coached by Jean as a golden gopher that I felt nurtured in a way that has had a life-long impact; the type of real time learning about being a female leader navigating amidst a world full of male leaders.

Jean was a quiet, yet forceful type of female leader. Her way of encouraging could be found through her piercing whistle, poolside chats and questioning of my sometimes playful attitude towards training (or off season antics). She carefully assigned me leadership “tests” throughout my years at Minnesota to encourage my steady progress. These ranged from hosting potential swimming recruits, to representing the “U” at functions and leading my peers as a captain. Her nature was to encourage and to strengthen my resolve to want to be better – as a swimmer and as a person. Her lasting touch of influence stays with me today.

As I stood at the dedication of the Jean K. Freeman Aquatics on December 6, 2014, I could imagine Jean would be blushing, humbled by all the attention. She was not one to revel in the spotlight, but one to want to push others to get there. Jean, you are most deserving of this lifetime achievement award of having a building named after you. Not because you or your family or swimmers gave millions of dollars to “buy” this for you (for we did not), but because of the legacy of a life well lived and a statement of the power of being a female mentor to thousands. I am proud of the University of Minnesota for naming a building after a person of worth, rather than the worth of a person. I am so proud of you, Jean. Of what you built at Minnesota and of the mentor you were to me and hundreds of others. Your goodness is having a ripple effect to other young women and will continue to do so as a living testimony of your life well led. I look forward to future visits to campus to again see the “house that Jean built” and also to remember the lessons you taught me and so many others.

Though you lost your battle to cancer, you won our hearts and your lessons live on in all who knew you. Welcome to the Jean K. Freeman Aquatic Center, home of my mentor, Jean Freeman.

My mother passed away unexpectedly 31 years ago. I was in college at the time and remember returning home for the funeral only to discover a partially packed box mom had been preparing to mail me for Halloween. The box contained a macrame skeleton and a hand stitched and stuffed orange pumpkin. I remember thinking at the time, and every time I touched these items, that these were my mom’s final gifts to me. But little did I know that over three decades later I would receive an unexpected gift.

The macramé skeleton enjoyed years of decorating our front stoop or porch while the boys were growing up. The toll of inclement fall weather deteriorated the gift; a tumble off its hook on a blustery day caused the already brittle scapula (wooden rod) to break a few years ago. The skeleton received a simple burial in our waste can. It was difficult to throw the battered skeleton away, knowing that my mother’s hands had lovingly made it for me. A mom who found her way through pottery, painting, batik and other arts to express herself; a mom who regularly shared her gifts, material and personal, with others. Unexpectely, my final gift perspective changed last summer during a visit to see my dad and step mom, Ruta.

My visits to Marietta had become more frequent the past two years, as Ruta’s health was declining due to her ALS, Lou Gerig’s disease. It was during my final visit while Ruta was alive that she asked my dad to bring me something. In a weak voice that I could barely understand, Ruta strained to say she had been meaning to make sure I got this for some time and apologized it took so long. Ruta said the she was uncertain, as was my dad, of whether this item was intended for me or whether my mom had purchased it for herself. Minutes later, my dad presented me with a spectaular hand carved round box. Upon opening the top of the box, I could see that a well preserved item was nestled inside; I unfolded the cotton and carefully unearthed the gift. The round box was obviously made by a master artist and was a gift in itself, but what was found inside made my heart pause. It was a ring that may never have been taken out of its encased nest. A gift waiting to be given for over three decades. Ruta reminded me that it was probably purchased during my mom and dad’s trip to China (my mother passed away shortly after that trip). My dad didn’t have much memory of the ring or its’ intended finger, but Ruta felt strongly it was meant to be a gift to me since it was still wrapped so perfectly and may have been intended to be a Christmas gift in 1983.

As I slipped the jade ring on my right ring finger, I admired the simple beauty of the stone and gold setting and then thought of my mother. Choking back the tears, I managed to whisper a “thank you” to Ruta, not knowing that this would also be the final gift she would give to me in person. It was only three months later that Ruta passed away from ALS.

Now, each time I wear the ring, it reminds me of the wonderful gift of my mom the first 22 years of my life and also of Ruta, the mom I was lucky enough to have for nearly 30 more. I find that the ring gives me the strength of two accomplished women, which both comforts and empowers me. Although I cherish my hand sewn pumpkin, I now have a new “final gift” to remember my mother by and a special memory of how that gift was given to me by Ruta.

We never know when we won’t have the time to present our loved ones with a final gift. Don’t wait to give yours to those you love. Simply saying “I love you” or giving a hug is a gift we can all afford to give. Who needs your gift today?

Peeling back the onion on a once-in-a-lifetime experience is complicated. My husband and I returned from Spain two weeks ago and a common question is, “So, how was it?” My answer was never what I wanted, but what can you expect from a hallway conversation or brief encounter when you don’t know if they really want or are ready for a long-winded emotional reply?

This week the students where I work (IMSA) asked me to speak at “Minds on the Mike,” a Ted-talk-like event put on by Student Council. I was forced to sit down, reflect and articulate about what I’d say in my seven minutes and was able to boil it down to a few points.

THE FOUR P’S OF EL CAMINO DE SANTIAGO

1. PREPARATION

Inspired to celebrate our milestone anniversary in a unique way, my husband and I started planning our trip to Spain to walk The Way of St. James (el Camino de Santiago) to count our blessings and ‘unplug’ from our daily lives. Equipment preparations for me began one year prior to departure, when I retired my external frame backpack used for Boy Scout High Adventure outings and purchased a new lightweight internal frame pack. Next came the light weight sleeping bag, waterproof pack cover, packable high performance clothing and so on. Steve took care of travel logistics (planes, trains, public transportation) and I found us a centrally-located hotel for our stay in Barcelona for our off Camino vacation. We allowed ourselves a very long planning period of over a year to assure we were ready.

The one part of preparation that really made a difference in the Camino experience was a distance walking program I developed. Our first walk (featured on the right) was 4 miles in early February, trudging through snow and cold. The past winter in Chicago was unforgiving; one could look at as an obstacle, but instead we viewed it as a field test for our outerwear and long underwear. Each weekend I would add one mile to our Saturday journey and then Sunday would be one mile less than Saturday – so 4/3 first weekend and 2 miles twice in the week, 5/4, 6/5 and so on until we hit 13/12 on the weekend and 6 miles in the week before we left in late April.

The one thing we couldn’t train properly for in Illinois was the hills and mountains. Somehow getting on a treadmill and tapping up the incline wasn’t quite the same and the Fox River bicycle trail (asphalt) couldn’t mimic trail conditions. The result was two major blessings: no blisters or injuries. Cafe con leche (coffee with milk) and mas pan “more bread” kept us going. Yes, preparation paid off.

2. PEOPLE

An entire blog could feature the people we met on the Camino. When we didn’t get their name, one was made up for them that equated to the place they “are from” or some key feature: Jackson Hole, Señor Valencia and such. One person I want to talk about is featured on the photo with me and his name was Frederick (from Germany). We met Frederick well into our Camino at the end of day 5. I overheard him talking to some ladies in the lobby of our hotel about his Camino, which started 89 days ago in Germany. He was unfolding maps and routes and was so fascinating that I invited myself (and Steve) to share dinner with him that night.

Frederick was an older gentleman, probably mid to late 60’s, who is a semi-retired architect in Germany. He designs upscale residential homes and was on the Camino for holiday and for also design inspiration. As he ordered his fine bottle of wine, he exclaimed that “life is too short to drink cheap wine,” and then proceeded to share his wine with us. “I like this guy,” I remember thinking as I sipped in the good stuff. It was later that we also discovered that he battled a major health issue in 2012 and this Camino trip was both a health goal and celebration of life. Every person we met had different intentions for their Camino; the shell we lashed onto our backpacks was the outer sign of our inner Camino and bound us together as we greeted one another with “Buen Camino” (good road) while passing along the trail.

3. PACE

As a natural athlete and sprinter, the thought of someone passing me never sits well. Yes, you can say I’m completive, always. In fact, long races or endurance contests are not really my bag. Despite this, I love the cadence and peace of long distance walking. One thing I didn’t consider was that there would be many rates of pace along the Camino and I would need to deal with the fact with shorter legs and a longer torso, that I’m not a swift walker. My pace allowed me to stop and take pictures, smell the flowers and admire the countryside. But day one with more people passing me on foot and by bicycle, I had to resolve with myself that this was not a race; we all would reach the finish line at our own pace. Once I came to resolution with this, the walk was much more about finding my personal rhythm and less about what other people’s speed was. I also learned from a biker who hopped off his bike to walk with us for awhile, that biking the Camino may allow you to cover more miles per day (significantly), but that you don’t really “see” the beauty of the trail. He started getting off his bike to meet people and also to let the scenery go by more slowly. I’m sure the butt break was also most welcome. No, my pace was just fine, and 1,023 photos and video clips and six days later, we reached our designation of Santiago and celebrated Divine Mercy Sunday at the Cathedral at the Noon Pilgrim’s Mass.

4. PILGRIMAGE

There is plenty of time to reflect when you walk 120 km through the Spainish countryside. There were dozens of churches to pray in, and kilometer markers to count off, as well as a 3:00 pm alarm on Steve’s watch that were constant reminders and cause to pause to reflect. Steve and I had never been on a two week vacation together and being away alone for 15 days was a gift in itself. Our pilgrimage was one of celebration for our marriage, our family and the many blessings that envelope us daily. We also enjoyed and appreciated the history, architecture, culture, landscape and people that blended to form our own personal Camino pilgrimage.

Before departing, as part of preparations, blessings and intentions were gathered from friends and family and written down on a pocket-sized journal that I carried in my backpack. As I entered churches and walked along, I offered up these daily, frequently thinking about the people who entrusted them to me to be part of my pilgrimage. It was a privilege to carry these and offer them up at the cathedral in Santiago. Steve found a side chapel where a religious statue beckoned me to place the journal in a basket. Steve likes to think that the incense used in the swinging ball used in the Pilgrims’ Mass was composed of books like ours. Yes, I’m going with that idea.

Our Camino was an experience that I’m still unpacking (literally and figuratively) and will forever change how I view my journey through life. As Steve and I completed over 100 km, we were presented with our official certificates after presenting our credentials with stamps from the places we visited along our route that verified our accomplishment. As the women inked in my Latin name (Brigidam McKenna), I felt a sense of personal and spiritual accomplishment. I’ve also come to realize that we are all on Camino and just need to remember our credentials and clam shell to encourage others to join us. Life is good and I wish you a Buen Camino.

While developing a new program, “Beyond Pink,” I came to a personal realization. Like Elisabeth Kübler-Ross‘ five stages of grief, I’ve moved through four distinct emotional stages of pink. Kuber-Ross outlined a series of emotional stages for death and dying: denial, anger, bargaining, depression, and acceptance. While researching the history of pink for a presentation at a cancer resource center, I was able to reflect on and compartmentalize my feelings as I moved through treatment. There is no research in connection with my stages of pink, only personal insights. Feel free to substitute the color pink with the color that represents your cancer or ailment. The world doesn’t revolve around pink, though during the month of October, one begins to wonder, but that’s for another blog. The four stages include: universal support, treatment turmoil, end of treatment and moving on. Let’s look at each of these separately.

First, Universal Support. This first stage is where we all start before cancer comes knocking at our door. It is a time for family and friends to engage in the larger cause of supporting a friend with (breast) cancer. The experience is second-hand and well meaning, but not first hand. I liken this to a time when my husband and I created a team at the ACS Relay for Life for our Confirmation class. We raised money, made team shirts, participated in the event, cheered on cancer survivors from the stands and walked laps of the track in support of “the cause.” It could also mean sponsoring a friend who is running or walking for a cause. Our donation feels good and it is something we can do to show others we care about what they are going through and do our small part to help work towards a cure.

Second is Treatment Turmoil. This is the stage that begins once you are diagnosed with cancer. You’ve now crossed the line to cancer patient. Pink now means something different to you during the month of October. It may make you angry when you see the ribbon emblazoned on products you need to purchase or you may feel supported. There is no right way to feel. Some will recoil from friends and family, others will proudly engage in events as a survivor. I recall participating in the same ACS Relay for Life event, this time invited to the survivor tent for dinner, prizes and a purple shirt. As I inked my handprint on the banner with purple paint, it branded my crossing over to Treatment Turmoil. Sitting on the track now instead of the stands and parading around the track as a survivor felt both weird and surreal. The stands full of Universal Supporters were now trying to honor and lift me up; it was both an uncomfortable, yet somehow supportive feeling.

The third stage is End of Treatment. It commences when you complete your treatment. For some, this is a stage filled with celebration, while for others it is clouded with depression and yet others feel like they want to give back. For me, I was hit immediately with a distinct feeling of fear and abandonment by my medical team. As I drove away from my last doctor’s appointment, I had no idea what I should be doing next. That might be because I had no cancer after care plan, but that is for another blog. I turned that fear around by focusing on my goal of participating in the upcoming Avon 2-Day walk. While training for that walk, the time set aside to walk and think were both therapeutic and part of my wellness plan to lose weight. Over the months, my fear turned into a sense of accomplishment and giving back when I reached the finish line 39.3 miles later at the end of the second day of the walk. This is the same year I sat in the stands again at the ACS Relay for Life. I somehow feel more comfortable in the stands rather than seated with the survivors on the field. Again, there is no right way to feel.

The fourth stage is Moving On. This is the time when you may want to forget about your cancer and treatment or help others through their cancer challenges. It may envelope you with the feeling you just want to feel or be treated normal again on one day and the next day you find yourself meeting a friend who just received news of a diagnosis. This is the stage I find myself in today. With a nagging thought now and again about recurrence, moving on is where I want to stay focused. As part of Moving On, I’ve set a new goal: walking The Camino, or Way of St. James with my husband in Spain in 2014. I’m a big believer of goal setting and encourage you to set goals no matter what stage you find yourself in today.

A final thought comes from interaction during my talk this week at Wellness Place. I was reminded that you may bounce back and forth through these stages as time moves on. A comment by a breast cancer survivor whose cancer has metastasized, is that you may not stay in any one stage and you can jump through stages out of order. We are human and shaped by our environment, support systems and circumstances. There is no right way to grieve and no prescribed way to feel. By acknowledging there are stages, maybe you won’t feel like your feelings are abnormal; you aren’t alone.

Wishing you love and support through all your stages, no matter where you are. Britta